Healthcare Provider Details

I. General information

NPI: 1861917684
Provider Name (Legal Business Name): KRISADEL C JOACHIM OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISADEL C ESPIRITU OTR/L

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 07/18/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PLITT AVE
FARMINGDALE NY
11735-5102
US

IV. Provider business mailing address

5 PLITT AVENUE
FARMINGDALE NY
11735
US

V. Phone/Fax

Practice location:
  • Phone: 917-209-2718
  • Fax:
Mailing address:
  • Phone: 917-209-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8296
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number21544
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number21544
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number21544
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: